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Simply Level Platinum (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Level Platinum (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply Level Platinum (HMO C-SNP) in 2025, please refer to our full plan details page.
Simply Level Platinum (HMO C-SNP) is a HMO C-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Broward, Palm Beach. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Simply Level Platinum (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Simply Level Platinum (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Simply Level Platinum (HMO C-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Simply Level Platinum (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $164.90. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3200.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Simply Level Platinum (HMO C-SNP) plan has an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. During the initial coverage phase, you will pay no copay for preferred generic drugs, and a $47 copay for standard generic drugs. For preferred brand drugs, you'll pay a $95 copay at preferred pharmacies, and a $100 copay at standard pharmacies. For non-preferred drugs, you will pay 33% coinsurance. The plan also has no copay for specialty tier drugs.
Additional Benefits
The Simply Level Platinum (HMO C-SNP) plan offers comprehensive coverage, including inpatient hospital stays with a $150 copay for the first five days, and no copay thereafter. It also covers outpatient services, primary care, preventive services, hearing, vision, dental, and home health services, often with no copay. The plan provides additional benefits such as ambulance and transportation services, emergency services, and medical equipment, with varying copays and coinsurance amounts. Other services like home infusion, dialysis, and skilled nursing facilities are covered as well.
Inpatient Hospital See details
The Simply Level Platinum (HMO C-SNP) plan covers inpatient hospital stays, with a copay of $150 for days 1-5 and no copay for days 6-90. Additional days and non-Medicare-covered stays for inpatient hospital are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $200, and observation services with a $200 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a $20 copay for both individual and group sessions. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Simply Level Platinum (HMO C-SNP) plan, and requires prior authorization and a doctor referral. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location have no copay for up to 24 one-way trips per year, while transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services with the Simply Level Platinum (HMO C-SNP) plan includes a $120 copay for emergency services and a $25 copay for urgently needed services, with no coinsurance. Worldwide emergency services, including worldwide emergency coverage, urgent coverage, and emergency transportation, also have a $120 copay, with a maximum plan benefit of $100,000.
Primary Care See details
The Simply Level Platinum (HMO C-SNP) plan covers primary care physician services and chiropractic services with no copay, and physician specialist services with a $20 copay. Occupational therapy, physical therapy, speech-language pathology, individual and group mental health, and individual and group psychiatric sessions all have a $20 copay.
Preventive Services See details
Preventive services are covered, but annual physical exams, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered. Medicare-covered preventive services, kidney disease education services, and other preventive services have no copay. Additional preventive services include health education, personal emergency response system, fitness benefit, remote access technologies, home and bathroom safety devices and modifications, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all of which have no copay.
Hearing Services See details
The Simply Level Platinum (HMO C-SNP) plan covers hearing exams with no copay, including routine hearing exams and fitting/evaluation for hearing aids, with no copay. Prescription hearing aids (all types) are covered with no copay, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear, with no copay for eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum plan benefit coverage of $225.00 per year. Upgrades are not covered.
Dental Services See details
Simply Level Platinum (HMO C-SNP) covers dental services, including oral exams, x-rays, and cleanings with no copay, and other services up to a $1,500 annual maximum. Restorative services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, oral surgery, and orthodontics are also covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Simply Level Platinum (HMO C-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Simply Level Platinum (HMO C-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral and prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $200, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $200, Therapeutic Radiological Services have a copay up to $60, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Simply Level Platinum (HMO C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services like Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. A doctor's referral and prior authorization are required, and copay information can be found in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Simply Level Platinum (HMO C-SNP) plan, requiring prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $60. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Simply Level Platinum (HMO C-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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